Health History Techniques

Assignment Requirements

Patient: 76-year-old Black/African-American male with disabilities living in an urban setting

Answer 1

The interview process with the patient is crucial for establishing a relationship, finding the problem, and addressing issues. “Establishing a positive patient relationship depends on communication built on courtesy, comfort, connection, and confirmation” (Ball, Dains, Flynn, Solomon, & Stewart, 2015, p. 2). This patient is currently living in an urban setting and is disabled. The basic interviews techniques would be first knocking on the door, introducing myself to the patient and also asking for his preferred name, Mr. S.

The interview would take place in a private setting such as an exam room, and with his disabilities would make sure he is accommodated to the fullest extent possible as to make him feel comfortable. I would make sure I am in front of Mr. S, sitting at eye level if possible and explain what I will be doing with obtaining his health history. I would ask him if it is okay to proceed and if he has anyone in the room with him if it is okay to ask questions in front of them ensuring that his information is private.  Open-ended questions, non-judgmental responses, and gentle guidance techniques can be used to direct the interview to be able to obtain vital information without over whelming the patient yet help form the picture that the patient presents to determine the best care plan.
The risk assessment tool that will be used on Mr. S is the Home Safety Self-Assessment Tool (HSSAT), this tool was developed to evaluate the living conditions of older adults and whether the home was a safe environment to prevent falls and also provide a space that older adults can stay in their home longer. “Being able to age in place is complicated when homes lack accessible features or when homeowners have been unable to keep up with home maintenance. Housing problems such as structural problems, fall hazards, or accessibility problems often negatively impact physical and mental health, increase fall risks and accidents, isolation, nutrition, and quality of life” (Horowitz, Nochajski, & Schweitzer, 2013, p.218). Although the assessment is often completed by occupational therapist going to assess the house, a modified version can be used in the interview process.

With Mr. S disabilities and age, it is important to assess his quality of life and safety. A functional assessment will also be needed in this interview to assess Mr. S. functional ability to care for his self and to determine what level of care he will need.  “The functional capacity must be assessed in order to plan specific interventions aimed at eliminating risk factors for disability and, simultaneously, promote health and prevent diseases that influence the functional capacity of the elderly, particularly those aged over 75 years” (Clemente et al., 2015, p. 66). Often multi-assessment is needed for those who are older because of their often multi-system diseases, and risk factors. The targeted questions I would ask Mr. S include
1. What are areas that you feel you need help in?
2. Do you live alone?
3. Do you feel safe in your current residence?
4. Have you fallen recently?
5. What medications are you currently taking and what method do you use to organize your medications?
6. Do you have family or friends that are close by or visit?
7. Are their stairs in your home?
8. How does your disability affect your quality of life?
9. Are you able to prepare meals for yourself?
10. Do you need assistance with bathing?
11. What level is your home on? Are their elevators available?
12. Do you drink alcohol or use any recreational drugs?

 

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, MO: Elsevier Mosby.

Clemente Rodrigues, R. M., Ribeiro da Silva, C. F., de Jesus Loureiro, L. M., Tavares da Silva, S. D., da Silva Crespo, S. S., & Sá Azeredo, Z. A. (2015). The oldest old: multidimensional functional assessment. Revista De Enfermagem Referência, (5), 65-74 10p. doi:10.12707/RIV14040

Horowitz, B. P., Nochajski, S. M., & Schweitzer, J. A. (2013). Occupational Therapy Community Practice and Home Assessments: Use of the Home Safety Self-Assessment Tool (HSSAT) to Support Aging in Place. Occupational Therapy In Health Care,27(3), 216-227 12p. doi:10.3109/07380577.2013.807450

 

Answer 2

Introduction

According to the location and specialty of your practice, you will be exposed to certain demographics of patients.  I live in south-central Georgia.  The rural community I live in has a diverse cultural pool, with a large number of African American residents. For this reason, I choose the seventy-six-year-old African American male with disabilities living in an urban setting.  I know that I live in a rural area, but I work at a regional medical facility that serves many surrounding counties of which some are considered rural, urban, and metropolitan according to the census.

Interview and Communication Techniques

In any interview process, a very important task to accomplish is trust between the nurse and the patient.  When dealing with elderly patients, it is important to make a solid first impression.  The patient should know that they are the center of attention, and “the health care provider will be open, honest, flexible, and eager to help them, addressing all questions and concerns” (Ball, Dains, Flynn, Solomon, & Stewart, 2015, p. 1).  When talking with the patient, make certain to set the tone and text accordingly.  Do not talk above the patient’s educational capabilities, but do not speak to the patient as if they are incapable either.
A great way to have a productive interview is to make it a face to face interview process in a secure, quiet, and well-lit room.  Seating should be comfortable, eye level, and have nothing separating the patient and nurse.  If it is approved by the patient, a family member or friend may be present to take notes or speak up for the patient.  Encourage the patient to wear their glasses if needed, as well as hearing aids.  Many times the patient may choose not to wear these supportive devices.  These factors can negatively affect the interview process because the patient will not accurately hear, or see what the nurse has said, shown, or demonstrated for the patient. This occurs because the patient does not want to appear disabled in any manner, which may be seen as a sign of weakness (Michigan, 2003).

Risk Assessment

The risk assessment tool that I selected for the elderly patient is the functional impairment assessment. The patient in this situation is elderly with disabilities.  Does the patient live by himself, or does he have anyone living with him.  Safety for the patient is a primary concern.  Items to be covered in relation to function include activities of daily living, along with instrumental activities of daily living.  ADL’s consist of bathing, toileting, dressing, transfers, grooming and feeding. IADL’s include driving, shopping, housekeeping, cooking, finances, and taking medications (Michigan, 2003).
The asking of specific questions is very important in the interview process. In relation to ADL’s, the patient must be asked if they are able to ambulate without assistance, or do they require assistance?  Has the patient had a fall recently, and if so how often?  If yes is answered to falls this is a serious health risk item (Ball et al., 2015).  Education and intervention can be applied at this time. Another question that is valid is can the patient drive to take care of financial obligations, and buy needed items like groceries and medications?  If not, how do they handle personal affairs, and get their food and medications?  Two more valid questions are, who performs the housework, and are you able to call for help if needed by telephone, or medical alert systems (Michigan, 2003)?

Conclusion

It is important to remember that the elderly are not always able to perform the basic functional needs to maintain a healthy, happy, and productive life.  It is important that health care providers be advocates for this population, and make sure these basic needs are being met.

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2015). Seidel’s guide to physical examination (8th ed.). St. Louis, Missouri: Elsevier Mosby.

University of Michigan Medical School. (2003). Geriatric functional assessment.
Retrieved from http://www.med.umich.edu/lrc/coursepages/m1/HGD/GeriatricFunctionalAssess.pdf

 

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